Contingency Management for Problematic Behavior Reduction in the Community

This study aims to determine the feasibility and effectiveness of implementing a contingency management program in a small group of mentally ill, unhoused individuals with schizophrenia or bipolar disorder and anosognosia (a lack of insight into their mental health) in the City of Tulsa. Tulsa's unhoused population grew nearly 7% last year to the highest numbers since the beginning of the COVID-19 pandemic according to Housing Solutions data, an organization that oversees many of the city's efforts to address homelessness. The primary objective of the study is to decrease disruptive or problematic behaviors by unhoused individuals in the community through monetary incentives.

Inclusion criteria

• Age 18-65 years old
• Diagnosis of Schizophrenia Spectrum, Bipolar, or Related Disorders
• Presence of Anosognosia (SUMD: Minimum combined score of 4 on questions 1) and 2); Recent (at least <6 months) history of disruptive behaviors (at least 1 disruptive behavior per week in >50% of weeks in the 6-month period prior to enrollment)
• Receive case management services through TDC
• Ability to comply with study procedures
• Willingness to participate in contingency management intervention

Exclusion criteria

• Inability to provide informed consent
• Unstable medical conditions that would interfere with participation
• Cognitive impairment that would interfere with participation in the study
• History of severe aggression or violent behavior posing a risk to study staff or other participants
• Active suicidal ideation or a history of suicide attempts within the past 12 months